The triplets were just 8 years old when they first watched their mother bring a baby into the world. There they stood, straight-backed against the wall of the delivery room of Baptist Hospital of Miami, six little eyes fixed on the tiny head emerging from between the legs of their mother's patient. "It's my first memory of feeling like I might faint," says Joanna Bedell, now 30. "The blood. The stretching." Her sister Sarah chimes in, "And the cursing." All three girls were confused by the wires attached to the newborn's head — fetal scalp electrodes — as it surfaced from the darkness. "I had no concept that they were put there by someone," says the third sister, Vicky. "I just thought, Oh, this is what goes on in an adult vagina." Something else they didn't know: This was only the first of many births they would witness, and one day they'd deliver babies for a living, too.
Throughout their childhood, the sisters learned a lot about what happens deep inside a woman's body. Both their parents were ob-gyns (the couple divorced when the triplets were toddlers), and as the girls grew up, they talked medicine with each of them. But their mom, Janet Gersten, made a point of showing her daughters every aspect of her practice. The girls got used to their mom being paged at all hours — in the middle of the night, of course, but also when they were at the mall, in a restaurant, or at the grocery store. If they didn't stay home with a sitter, the triplets sometimes camped out in the doctors' lounge, doing homework and snacking on crackers and cranberry juice.
Over the years, Gersten let them shadow her during routine hospital rounds. She enlisted their help around the office on weekends and brought her impassioned advocacy work to the dinner table, discussing a woman's right to quality care, from reproductive freedom to better insurance coverage.
By exposing her kids to her work, Gersten gave them knowledge that few other children were privy to. "I was very proud that my daughters were the only ones in fifth grade health class who even knew what a Pap smear was," she says. When she was starting a medical research company while still practicing as a doctor, they helped her organize blood and amniotic fluid samples. "I became very entrepreneurial," Gersten says. "I wanted to pass that down to my girls."
Gersten succeeded in inspiring her daughters beyond her wildest imagination. They all went to medical school, all specialized in obstetrics and gynecology, and this summer, when all three conclude their medical residencies, these highly skilled identical triplet M.D.'s will join their mom at her practice, the renamed New Age Women's Health, one of the most unusual medical practices anywhere.
The triplets will bring with them a wealth of updated know-how. "Each of us has been trained by different doctors in different techniques in different hospitals," says Joanna. "It will be amazing to pool this knowledge, teach each other, and learn from one another."
Take the issue of managing labor when a baby isn't progressing down the birth canal. Joanna, in residency at Tufts Medical Center in Boston, has been taught to deliver using a vacuum technique. During Sarah's residency at UT Southwestern Medical Center in Dallas, she learned exclusively to use forceps. Vicky, a resident at Barnes Jewish Hospital at Washington University in St. Louis, was taught both ways. "The great thing is that we get to pick each other's brains and choose for ourselves what we think is the best technique for a particular situation," says Sarah. "In certain ways, we can train each other."
Plus, Gersten has some old-school skills that none of her daughters have learned — like how to perform vaginal and cervical biopsies in the office. "In city hospitals they usually send you to the OR for those kinds of procedures and put patients under general anesthesia," Joanna says. "I look forward to learning from my mom how to do them quickly and painlessly in the office without our patient needing to go to the hospital."
That's where Gersten's wisdom will matter most: in teaching her daughters real-world ways to make life easier for patients, which tests to order and which ones are superfluous, and, most important, how to listen to the women who come to them, hold their hands, and build a long-lasting foundation of trust and confidence. Gersten speaks lovingly of patients who have been with her for more than three decades: "I've delivered their babies and am now treating them through menopause. Some of their kids are my patients now and having their own babies. I parade these women around the office and say, 'Look! I delivered her!' It's amazing that my kids will be taking care of kids that I delivered."
The triplets are sitting in a restaurant in Dallas, where they attract the sort of gawking that, by now, they barely notice. They are identical, save for minor differences: Vicky stands 5-foot-11, Sarah is 5-foot-101/2, and Joanna is 5-foot-9. ("It's because I was born last," Joanna quips.) They're also beautiful, willowy, and killer smart.
Later, Gersten joins in from Miami via Skype, and they chat about expectations for their upcoming collaboration. Gersten is genuinely surprised to learn about some of the protocols her daughters will be bringing with them — for example, screening for lifestyle issues. In her early years, Gersten didn't typically ask about intimate partner violence, sexual orientation, or whether patients wear seat belts or keep a gun in their home. "We ask those questions all the time," says Sarah. "It's our training." Before Gersten retired from delivering babies 16 years ago, she says she didn't routinely inquire about postpartum depression, which her daughters do. "We depended on patients to tell us they were depressed. But now I will adopt these protocols. My girls and I have a lot to teach each other."
During med school and their residencies, the triplets didn't call home for Gersten's medical expertise; they could ask the physicians they were working with and each other. They reached out when they just needed their mom. Recently, Joanna called Gersten in tears after a 28-year-old woman died tragically from septic shock in the operating room. Vicky had her phone-home moment last June. At the end of her first 24-hour stint as chief resident, she encountered a patient who had suffered an amniotic fluid embolism — when debris like fetal cells invade the bloodstream and cause a potentially fatal allergic reaction. The woman appeared to have died in her hospital bed. "She had no pulse," said Vicky, who watched the nurses perform CPR and chest compressions to try to revive her. "The mother wasn't breathing; I had to do what I could." So she performed a C-section. After Vicky pulled the baby out, the mother's pulse returned, stunning the medical team. "When I was done with my shift at 7 A.M., I drove out of the parking lot, pulled over at the side of the road, called my mom, and completely lost it.
"My mom is my go-to person for emotional support," Vicky continues, and adds that the same is true for her sisters. "It's so much more important than asking for medical advice; anyone around me can give me that. It helps that she knows how things can get suddenly scary and what it's like to be elbow-deep in training. But mostly I need her as my mom."
Gersten, now 64, started her practice in 1983, a time when AIDS was just beginning to be considered a blood-borne disease, doctors believed herpes (not HPV) caused cervical cancer, and female ob-gyns were a rarity. (Gersten was one of only a few in Miami.) While certain fundamentals of gynecology remain constant— women will always get pregnant, contract urinary tract infections, and need access to birth control — much of its landscape has shifted in those nearly 35 years. Today, for example, 85% of ob-gyn residents are female. The world is also wildly complicated. A patient's gender is no longer a given, her first sexual encounter often occurs when she's younger, and technology can now detect pregnancy and fetal viability at a much earlier stage. And in the Eighties, most women never considered waxing off their pubic hair or "rejuvenating" their vagina. "Pornography changed things," says Gersten. "Women see other women in the videos and start to wonder, What do I look like? Oh, please! Who is setting this standard of what's supposed to be attractive there? Like every face, every vagina is different, and that's what I tell anyone who's concerned."
Gersten's patients come to her with everyday maladies that the triplets rarely saw in their residencies, when the focus was on surgery and major complications. Bacterial vaginosis, yeast and bladder infections: "These are things I can educate them about," says Gersten. She'll also help her daughters become expert in menopause and postmenopause, stages that last decades for most women and often serve up a panoply of bothersome symptoms. Says Gersten: "Obstetrics is 90% routine and 10% panic. More than any other specialty, in obstetrics things happen without warning — babies gets stuck, women bleed uncontrollably, babies die. After you're trained in emergencies, routine stuff is easy. They just have to learn it."
And they'll all face issues that didn't exist 30 years ago, at least not as intensely. One is obesity (the CDC reports that the rate doubled between 1980 and today), which increases the risk for gestational and type 2 diabetes. They'll also deal with the opioid epidemic and, since their practice is in Miami, with Zika, the mosquito-borne virus that can cause microcephaly and other devastating brain defects in newborns.
Growing up with our mother, we learned how to fight for what we believe in," says Joanna. When the girls were about 11 years old, Baptist Hospital, where Gersten worked, was set to merge with Mercy Hospital, a large Miami Catholic institution. This meant that doctors from Baptist would no longer be able to perform abortions, and Gersten wasn't having any of it. "I gathered up support from my colleagues, and we fought it, and fought it hard," she says. She won; Baptist and Mercy hospitals never merged.
Gersten's example helped the triplets become advocates when they went off to college at Brandeis University in Boston. Back in Miami, they were their mother's first three patients to be treated with Gardasil, a vaccine that protects against certain high-risk strains of HPV, the sexually transmitted disease that can lead to cervical cancer. When they got to college, Gersten was outraged that the student health insurance didn't cover the shots that could protect so many more young women. "I told my girls they had to educate people on campus about the importance of this vaccine, and that if student health insurance didn't cover it, the student health center should provide it for free."
So the girls enlisted the support of the college's premedical society, set up tables with petitions, and handed out Gardasil brochures with free condoms attached to entice students to take them. "We were up for days clipping on those condoms," says Joanna. The triplets got about 900 signatures. And by year's end, anyone who wanted Gardasil on campus could get it. For free. "Thanks to us, yes," says Joanna. "But also thanks to our mother for urging us to do it."
For most of their lives, the triplets have supported one another like the three legs of a stool; med school was the first time they were apart in any way. And four months into their residencies, a single event led to their decision to forge a family practice. In October 2013, their father was killed in a car accident.
They all remember where they were when they heard the news. "I was watching an ultrasound of a patient carrying triplets," says Vicky. Joanna was awakened from a sound sleep after finishing a long shift. "I was in the ICU," says Sarah.
In the aftermath of the tragedy, the girls felt one thing for sure: When bad things happen, they need to be together. They decided unanimously not to go for prestigious subspecialties after their residencies, which would have required at least three extra years of training and separation. Rather, they resolved to finish their residencies and head home. "We needed to get back to the people we loved and felt comfortable with," says Vicky.
"People assume that it was always our plan to take over our mother's practice," Joanna adds. "But it really wasn't. Our dad's passing had a big hand in that."
It's only now, as they prepare to embark on this professional adventure, that the triplets seem to more fully understand the uniqueness of their sisterhood. "My sisters and I grew up around the same friends, the same schools; our situation didn't seem so unusual," Vicky says. "But now when I tell people I'm a triplet and will be working with my sisters and my mom, they get very excited for me, and I start to realize how lucky I am, that we are, to be doing this together."
What the triplets look forward to most in their new practice is the chance to earn the love, trust, and gratitude of their patients, just as their mother and father did. Wherever they went as little kids, women would run up to their parents, their arms outstretched. "Oh, you delivered my baby," Vicky remembers so many of them saying. "Thank you so much."
This article originally appeared in the June 2017 issue of Dr. Oz the Good Life.
